Evaluation report

2010 Kenya: Community Strategy Evaluation

Executive summary

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Background:

The Ministry of Public Health and Sanitation (MoPHS) adopted the Community HealthStrategy in the year 2006 to actively engage the communities in managing their ownhealth (MoH, 2005). The strategy aims at improving health indicators by implementingsome very critical interventions at the community level. The overall goal of thecommunity strategy is to enhance community access to health care in order to improveproductivity and thus reduce poverty, hunger, and child and maternal deaths, as wellas improve education performance across all the stages of the life cycle and thegovernment has achieved 7% coverage to date. Non-governmental and communitybased organizations (CBOs) have also been involved in the implementation of thestrategy at grass-root levels.

Purpose/Objective:

The main purpose of the evaluation was to establish the effectiveness and relevance ofthe community health strategy as well as take cognizance of the lessons learnt withregard to empowering communities in taking charge of their own health. Theevaluation utilized a triangulation approach in data collection. The main data collectionmethod was a household survey in which 3884 respondents were interviewed. Therespondents were randomly selected from 21 of the 64 districts where the communityhealth strategy has been implemented by the Global Alliance for Vaccines andImmunization (GAVI).

Methodology:

Qualitative data was collected through Focus Group Discussions (FGDs) withCommunity health workers and beneficiaries. In addition, more data was collectedthrough Key Informant Interviews (KIIs) with stakeholders and partners at District,provincial and national levels. In this regard 40 FGDs were conducted and 120 KIIscarried out with District Health Management Team (DHMT) members in the selecteddistricts and an additional 10 other KIIs with partners and MoPHS at the national level.

Findings and Conclusions:

The evaluation established that the services currently being offered by the CommunityStrategy at level one in Kenya under the hygiene and sanitation such as water safety,food hygiene and solid waste disposal among others are relatively morecomprehensively covered as compared to the other components.

Results from KIIs with CHEWs and FGDs with CHWs showed there was an establishedlink between the community and the health facilities. This was mainly through thecoordination between PHT-CHEW and the CHWs who participated in identifying casesof illnesses at the community level and referring them to the health facilities. Afterinterviewing the CHEWs and CHWs as well as holding discussions with thebeneficiaries in the CUs, it was revealed that the community was increasingly becomingaware of their rights to quality health care. However community members were notadequately empowered to demand for the services and there was lack of clearstructures for addressing their grievances.It was established that, the community based health information management was notvery effective. However, not all CUs were introduced to the CBHIS and some data toolswere developed by NGOs in their specific programmes. Information collected includedthe mothers referred for ANC, exclusive breastfeeding, children receiving vitamin A,ART defaulters among others.

Recommendations:

The training of CHWs should be re-designed and delivered in phases (several shorttraining modules spread over time) covering more content. Such multi-phasedtraining will increase the retention rate because the CHWs will anticipate furthertraining and probably develop a career path. This approach has worked very well inMalawi and successful participants have been recommended for further training.• There is a need for advocacy to ensure that all partners/ministries of governmentadopt the community unit as the unit for all developmental work to ensuresynergy• There is a need to ensure that if trained health workers are to be CHEWs workingwith the community health strategy, then their functions should be included in thebasic/pre-service training and they should only be deployed for this work.Otherwise there is need to develop a new cadre of workers specifically for CS as hasbeen the case in Ethiopia.There is need for production and dissemination of key health messages of CStargeting high impact interventions. These should include effective communicationmechanisms through visual and audiovisual channels.• There should be improved staffing of the facilities where CUs are linked in order tostrengthen referrals and linkage systems especially taking into consideration thespatial distribution and population density. This will improve support supervisionfrom CHEWs to CHWs during their community work.

Lessons Learned (Optional):

The main lessons learnt from the evaluation are as follows;-• Participation of community members in strengthening health systems elicited grassroot acceptance, support and sense of ownership. This resulted in increased demandfor health services at level 1 therefore improving health of the target population.• Active supervision and linkages forged between DHMT, CHEWs, CHWs, and CHCplayed a key role in the sustainability of the programme.• Creating community demand for health services by government and partners mustbe matched with the availability of improved services within health facilities.• A comprehensive, integrated approach to a multidimensional health programmehelps ensure that communities ultimately access the services they need.